Everyone Deserves A Decent Place To Live

An affiliate of Habitat for Humanity, Inc. Americus, GA

1757 North East Avenue • Sarasota, FL 34234 (941) 487-5520 Fax: (941) 363-7775 homeownerservices@habitatsrq.org www.habitatsrq.org

Critical Home Repair Program Frequently Asked Questions Updated: May 2019

1. WHAT IS THE CRITICAL HOME REPAIR PROGRAM?

The intention of this program is to eliminate health and safety defects from the home; barrier removal to improve housing conditions for accessibility; special needs; and assist seniors to age in place.

2. WHAT REPAIRS ARE ELIGIBLE?

• Installing new roofs

• Replacing old and broken heating and cooling systems

• Replacing water and sewer lines

• Replacing water heaters

• Removal of health and safety barriers

• Eligible repairs cannot exceed the cost of $12,000. Mobile homes are not eligible for assistance.

3. HOW DO I QUALIFY?

• The applicant must be listed on the deed and live in the home as their primary residence.

• The mortgage on the home and the property taxes must be current.

• The home must be located within Habitat Sarasota affiliate boundary area.

• The current value of the home must be less than $272,000 as determined by the Sarasota Property Appraiser.

• The total household income must not exceed the income limits shown on the table below.

4. Your household income must be verifiable and include all sources (including Social Security, Child Support, Disability, Alimony, Wages, etc.). You must exhibit job stability, with at least 2 years of consistent employment. Household maximums are determined by family size and are adjusted annually based on HUD income limits (see table below).

5. Your credit and criminal history will be reviewed. Bankruptcies or foreclosures must be at least 4 years old. Collections must be resolved. All medical collections must have an active payment plan in place. Credit is checked during the application process and a fee is collected at the time the credit is requested.

6. HOW CAN I APPLY?

Applications are available at: www.habitatsrq.org. Applications are available to pick up at our Administrative Office located at:1757 N. East Ave., Sarasota, FL 34234 during normal business hours.

7. WHAT ARE THE PAYMENT TERMS?

A credit report will be pulled to determine payment/ability to pay. HFHS provides affordable repayment terms at 0%interest based upon the applicant’s ability to pay.

We are pledged to the letter and spirit of the U.S. policy for the

achievement of equal housing opportunity throughout the nation. We

encourage and support an affirmative advertising and marketing program

in which there are no barriers to obtaining housing because of race, color,

religion, sex, handicap, familial status, or national origin.

Family Size Habitat Maximum Income

1 39,700 2 45,400 3 51,050 4 56,700 5 61,250 6 65,800 7 70,350 8 74,850

Everyone Deserves A Decent Place To Live

An affiliate of Habitat for Humanity, Inc. Americus, GA

CRITICAL HOME REPAIR CHECKLIST

Thank you for your interest in applying for the Habitat for Humanity Sarasota Critical Home

Repair program. Please complete the attached application and submit with the following

documents:

___ Copy of driver license for all applicants

___ Copy of birth certificate for everyone living in the home

___ Copy of Social security card for everyone living in the home

___ Proof of citizenship if born outside the US

(US Passport, Cert. of Naturalization, Permanent Resident Card)

___ Last 4 paystubs for anyone 16 or older who is working

___ 2018 and 2017 tax returns

___ 2018 and 2017 W2s

___ Bank statements (6 months of checking and 1 month of savings)

___ Copy of current mortgage statement

___ Copy of current homeowner’s insurance policy

___ Copy of the deed

___ Copy of title policy

___ Award letters for assistance income (If applicable)

• Child support (Orders, Decrees)

• SSI or disability

___ DD214 (If applicable)

___ Borrower’s Authorization Form

___ Social Security Verification Form SSA-89

___ Income Tax Request Form 4506-T

INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.

ALL FIELDS MUST BE COMPLETE AND ALL DOCUMENTS

MUST BE ATTACHED.

5/19

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Application Critical Home Repair Program

1. APPLICANT INFORMATION

Applicant Co-applicant

Applicant’s name Applicant’s email: Co-applicant’s name

Social Security number

Home phone Age

□ Married □ Separated □ Unmarried (Incl. single, divorced, widowed)

Social Security number

Home phone Age

□ Married □ Separated □ Unmarried (Incl. single, divorced, widowed)

Dependents and others who will live with you

(not listed by co-applicant)

Name Age Male Female

Dependents and others who will live with you

(not listed by co-applicant)

Name Age Male Female

Present address (street, city, state, ZIP code) □ Own

Present address (street, city, state, ZIP code) □ Own

Is the above address your primary residence? □ Yes □ No

Do you rent the property to others □ Yes □ No

Is your mailing address different than above? □ Yes □ No

If yes, list mailing address (street, city, state, ZIP code)

Is your mailing address different than above? □ Yes □ No

If yes, list mailing address (street, city, state, ZIP code)

2. FOR OFFICE USE ONLY — DO NOT WRITE IN THIS SPACE

Date received:

Date of adverse action letter:

Date of approval:

Date of commitment letter:

Dear Applicant: Please complete this application to determine if you qualify for the Habitat for Humanity Sarasota Critical Home Repair program.

Please fill out the application as completely and accurately as possible. All information you include on this application will be kept confidential in

accordance with the Gramm-Leach-Bliley Act.

We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status or national origin.

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3. WILLINGNESS TO PARTNER

To be considered for Habitat Critical Home Repair Program, you and your family must be willing to make the property available for inspection by Habitat for Humanity Sarasota, Inc or its agents before and after the completed repairs to your home.

I AM WILLING TO MAKE MY HOME AVAILBLE FOR INSPECTION:

Yes No

Applicant

Co-applicant

4. TYPE OF CRITICAL HOME REPAIR

Select the type of Critical Home Repair you are applying for:

□ Roof □ Hot Water Heater □ Heating and Air Conditioning □ Plumbing

□ Other (please describe)

In the space below, describe the Critical Home Repair issue.

5. ADDITIONAL PROPERTY INFORMATION

1. What is your monthly mortgage payment? $ Unpaid balance $

2. What is your annual property taxes? $ Annual Homeowners Insurance $

3. Are there any liens on your property? □ No □ Yes If yes, list amount $

4. Do you own any other real estate? □ No □ Yes If yes, list property address $

6. OPTIONAL INFORMATION

1. Did you contact any agency prior to Habitat? □ No □ Yes If yes, list name:

2. Which agency/person referred you to our program?

3. What school(s) do your dependents attend?

4. Is any member of your household disabled? □ No □ Yes

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8. MONTHLY INCOME

Income source Applicant Co-applicant Others in household Total

Wages $ $ $ $

Alimony $ $ $ $

Child support $ $ $ $

Social Security $ $ $ $

SSI $ $ $ $

Disability $ $ $ $

Other: $ $ $ $

Other: $ $ $ $

Other: $ $ $ $

Total $ $ $ $

PLEASE NOTE: HOUSEHOLD MEMBERS WHOSE INCOME IS LISTED ABOVE

Self-employed

Name Income source Monthly income Date of birth applicants may be

required to provide

additional

documentation such

as tax returns and financial statements.

7. EMPLOYMENT INFORMATION

Applicant Co-applicant

Name, address, and phone of CURRENT employer

Years on this job Name, address, email and phone of CURRENT employer

Years on this job

Monthly (gross)

wages

$

Monthly (gross)

wages

$

Human Resources contact Email address Human Resources contact Email address

If working at current job less than one year, complete the following information

Name and address of LAST employer Years on this job Name and address of LAST employer Years on this job

Monthly (gross)

wages

$

Monthly (gross)

wages

$

Type of business Business phone Type of business Business phone

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9. ASSETS

Name of bank, savings and

loan, credit union, etc.

Address

City, state

ZIP

Account number

Current

balance

$

$

$

$

$

$

$

$

$

10. DEBT

TO WHOM DO YOU AND THE CO-APPLICANT(S) OWE MONEY?

APPLICANT CO-APPLICANT

Account

Monthly

payment

Unpaid

balance

Months

left to pay

Monthly

payment

Unpaid

balance

Months

left to pay

Other motor vehicle $ $ $ $

Boat $ $ $ $

Furniture, appliance, TVs

(includes rent-to-own)

$

$

$

$

Alimony $ $ $ $

Child support $ $ $ $

Credit card $ $ $ $

Credit card $ $ $ $

Credit card $ $ $ $

Total medical $ $ $ $

Other $ $ $ $

Other $ $ $ $

Total $ $ $ $

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MONTHLY EXPENSES

Account Applicant Co-applicant Total

Mortgage $ $ $

Utilities $ $ $

Insurance $ $ $

Child care $ $ $

Internet service $ $ $

Cell phone $ $ $

Land line $ $ $

Business expenses $ $ $

Other $ $ $

Other $ $ $

Other $ $ $

Total $ $ $

11. DECLARATIONS

Please check the box beside the word that best answers the following questions for you and the co-applicant

Applicant Co-applicant

a. Do you have any outstanding judgments because of a court decision against you? □ Yes □ No □ Yes □ No

b. Have you been declared bankrupt within the past seven years? □ Yes □ No □ Yes □ No

c. Have you had property foreclosed on or deed in lieu of foreclosure in the past seven years? □ Yes □ No □ Yes □ No

d. Are you currently involved in a lawsuit? □ Yes □ No □ Yes □ No

e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure,

transfer of title in lieu of foreclosure, or judgment?

□ Yes □ No □ Yes □ No

f. Are you currently delinquent or in default on any federal debt or any other loan, mortgage

financial obligation or loan guarantee?

□ Yes □ No □ Yes □ No

g. Are you paying alimony or child support or separate maintenance? □ Yes □ No □ Yes □ No

h. Are you a co-signer or endorser on any loan? □ Yes □ No □ Yes □ No

i. Are you a U.S. citizen or permanent resident? □ Yes □ No □ Yes □ No

j. Are you a member of the US Armed Forces? □ Yes □ No □ Yes □ No

If you answered “yes” to any question a through h, or "no" to question i, please explain on a separate piece of paper.

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12. AUTHORIZATION AND RELEASE

I understand that by filing this application, I am authorizing Habitat for Humanity Sarasota to evaluate my actual need for the Critical

Home Repair program, my ability to repay an affordable loan, and my willingness to be a partner.

I understand that the evaluation will include personal visits, a credit check and employment verification. I have answered all the questions

on this application truthfully. I understand that if I have not answered the questions truthfully, my application may be denied. The original or

a copy of this application will be retained by Habitat for Humanity Sarasota even if the application is not approved.

I also understand that Habitat for Humanity Sarasota screens all applicants on the sex offender registry. By completing this application, I

am submitting myself to such an inquiry. I further understand that by completing this application, I am submitting myself to a criminal

background check.

Applicant signature Date Co-applicant signature Date

PLEASE NOTE: If more space is needed to complete any part of this application, please use a separate sheet of paper and attach it to

this application. Please mark your additional comments with “A” for applicant or “C” for co-applicant.

13. WARNING

Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements

to any department of the United States Government.

Applicant's name Co-applicant's name

14. STATEMENT

The applicant understands that the application is subject to Florida’s public records laws.

7

15 . INFORMATION FOR GOVERNMENT MONITORING PURPOSES

PLEASE READ THIS STATEMENT BEFORE COMPLETING THE BOX BELOW: We are requesting the following information to monitor

our compliance with the federal Equal Credit Opportunity Act, which prohibits unlawful discrimination. You are not required to provide this

information. We will not take this information (or your decision not to provide this information) into account in connection with

your application or credit transaction. The law provides that a creditor may not discriminate based on this information, or based on

whether or not you choose to provide it. If you choose not to provide the information, we may note it by visual observation or surname.

Applicant Co-applicant

□ I do not wish to furnish this information

Race (applicant may select more than one racial designation):

□ American Indian or Alaska Native

□ Native Hawaiian or other Pacific Islander

□ Black/African-American

□ White

□ Asian

Ethnicity:

□ Hispanic or Latino □ Non-Hispanic or Latino

Sex:

□ Female □ Male

Birthdate:

/ / Marital status:

□ Married □ Separated □ Unmarried (single, divorced, widowed)

□ I do not wish to furnish this information

Race (applicant may select more than one racial designation):

□ American Indian or Alaska Native

□ Native Hawaiian or other Pacific Islander

□ Black/African-American

□ White

□ Asian

Ethnicity:

□ Hispanic or Latino □ Non-Hispanic or Latino

Sex:

□ Female □ Male

Birthdate:

/ / Marital status:

□ Married □ Separated □ Unmarried (single, divorced, widowed)

To be completed only by the person conducting the interview

This application was taken by:

□ Face-to-face interview

□ By mail

□ By telephone

Interviewer’s name (print or type)

Interviewer’s signature Date

Interviewer’s phone number

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Everyone Deserves A Decent Place To Live

An affiliate of Habitat for Humanity, Inc.

Americus, GA

EQUAL CREDIT OPPORTUNITY ACT NOTICE

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants

on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the

capacity to enter into a binding contract); because all or part of the applicant's income derives from any

public assistance program; or because the applicant has in good faith exercised any right under the

Consumer Credit Protection Act. The Federal Agency that monitors compliance with this law concerning

this company is the Federal Trade Commission, with offices at: [FTC Regional Office for the Southeast

Region, FTC- 225 Peachtree Street, N.E. Suite 1500, Atlanta Ga., 30303 or Federal Trade Commission,

Equal Credit Opportunity, Washington, DC 20580.

You need not disclose income from alimony, child support or separate maintenance payment if you

choose not to do so. However, because we operate a Special Purpose Credit Program, we may request

and require, in order to determine an applicant's eligibility for the program and the affordable mortgage

amount, information regarding the applicant's marital status; alimony, child support, and separate

maintenance income; and the spouse's financial resources.

Accordingly, if you receive income from these sources and do not provide this information with your

application, your application will be considered incomplete and we will be unable to invite you to

participate in the Habitat program.

Print Name: Print Name:

Date: Date:

1 of 2

E-SIGN ACT DISCLOSURE AND AGREEMENT

Dear Applicant,

We are pleased to offer you the opportunity to receive information about your account electronically. If you

would like to receive correspondence and notices from us electronically, instead of paper copies through the mail,

please review this notice and provide your consent.

1. Scope of Communications to Be Provided in Electronic Form. When you use a product or service to which

this disclosure applies, you agree that we may provide you with any communications in electronic format, and

that we may discontinue sending paper communications to you, unless and until you withdraw your consent

as described below. Your consent to receive electronic communications and transactions includes, but is not

limited to:

• All legal and regulatory disclosures and communications associated with the product or service available

through Habitat for Humanity Sarasota.

• Notices or disclosures about a change in the terms of your account or associated payment feature and

responses to claims.

• Privacy policies and notices.

2. Method of Providing Communications to You in Electronic Form. All communications that we provide to

you in electronic form will be provided either (1) via e-mail, (2) by access to a web site that we will designate

in an e-mail notice we send to you at the time the information is available, or (3) to the extent permissible by

law, by access to a web site that we will generally designate in advance for such purpose.

3. How to Withdraw Consent. You may withdraw your consent to receive communications in electronic form by

contacting us at apply@habitatsrq.org or 1757 N East Ave Sarasota, FL 34234. At our option, we may treat

your provision of an invalid email address, or the subsequent malfunction of a previously valid email address,

as a withdrawal of your consent to receive electronic communications. We will not impose any fee to process

the withdrawal of your consent to receive electronic communications. Any withdrawal of your consent to

receive electronic communications will be effective only after we have a reasonable period of time to process

your withdrawal.

4. How to Update Your Records. It is your responsibility to provide us with true, accurate and complete e-mail

address, contact, and other information related to this E-Sign Act disclosure and your account, and to

maintain and update promptly any changes in this information. You can update information (such as your e-

mail address) by contacting us at apply@habitatsrq.org or 1757 N East Ave Sarasota, FL 34234.

2 of 2

5. Hardware and Software Requirements. In order to access, view, and retain electronic communications that

we make available to you, you must have:

• an Internet browser that supports 128 bit encryption;

• sufficient electronic storage capacity on your computer's hard drive or other data storage unit;

• an e-mail account with an Internet service provider and e-mail software in order to participate in

our electronic communications programs;

• a personal computer (for PC's: Pentium 120 MHz or higher; for Macintosh, Power Mac 9500,

Power PC 604 processor 120-MHz Base or higher), operating system and telecommunications

connections to the Internet capable of receiving, accessing, displaying, and either printing or

storing communications received from us in electronic form via a plain text-formatted e-mail or

by access to our web site using one of the browsers specified above;

• Adobe Reader version 8.0 or higher.

6. Requesting Paper Copies. We will not send you a paper copy of any communication, unless you request it or

we otherwise deem it appropriate to do so. You can obtain a paper copy of an electronic communication by

printing it yourself or by requesting that we mail you a paper copy, provided that such request is made within

a reasonable time after we first provided the electronic communication to you. To request a paper copy,

contact us at apply@habitatsrq.org or 1757 N East Ave Sarasota, FL 34234. We may charge you a reasonable

service charge for the delivery of paper copies of any communication provided to you electronically pursuant

to this authorization. We reserve the right, but assume no obligation, to provide a paper (instead of electronic)

copy of any communication that you have authorized us to provide electronically.

7. Communications in Writing. All communications in either electronic or paper format from us to you will be

considered "in writing." You should print or download for your records a copy of this disclosure and any

other communication that is important to you.

8. Federal Law. You acknowledge and agree that your consent to electronic communications is being provided in

connection with a transaction affecting interstate commerce that is subject to the federal Electronic Signatures

in Global and National Commerce Act, and that you and we both intend that the Act apply to the fullest extent

possible to validate our ability to conduct business with you by electronic means.

9. Termination/Changes. We reserve the right, in our sole discretion, to discontinue the provision of your

electronic communications, or to terminate or change the terms and conditions on which we provide

electronic communications. We will provide you with notice of any such termination or change as required

by law.

10. Consent. By signing below you agree that you have read, understand, and agree to the E-Sign. You hereby

give your affirmative consent to provide electronic communications to you as described herein. You further

agree that your computer satisfies the hardware and software requirements specified above and that you have

provided us with a current e-mail address at which we may send electronic communications to you.

Acknowledged and Agreed to by:

______________________________________

Name: ________________________________

Date: _________________________________

Borrowers' Certification and Authorization

CERTIFICATION

The Undersigned certify the following:

1. I/We have applied for a mortgage loan through __________________________________. In applying

for the loan, I/We completed a loan application containing various information on the purpose of the

loan, the amount and source of the down payment, employment and income information, and the assets

and liabilities. I/We certify that all of the information is true and complete. I/We made no

misrepresentations in the loan application or other documents, nor did I/We omit any pertinent

information.

2. I/We understand and agree that ___________________________________________reserves the right to

change the mortgage loan review processes to a full documentation program. This may include verifying

the information provided on the application with the employer and/or the financial institution.

3. I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to

knowingly make any false statements when applying for this mortgage, as applicable under the

provisions of Title 18, United States Code, Section 1014.

AUTHORIZATION TO RELEASE INFORMATION

To Whom It May Concern:

1. I/We have applied for a mortgage loan through ________________________________. As part of

the application process, _____________________________________ and the mortgage guaranty insurer

(if any), may verify information contained in my/our loan application and in other documents required in

connection with the loan, either before the loan is closed or as part of its quality control program.

2. I/We authorize you to provide to ________________________________ and to any investor to

whom ___________________________________ may sell my mortgage, any and all information and

documentation that they request. Such information includes, but is not limited to, employment history

and income; bank, money market and similar account balances; credit history; and copies of income tax

returns.

3. ____________________________________ or any investor that purchases the mortgage may address

this authorization to any party named in the loan application.

4. A copy of this authorization may be accepted as an original.

Borrower Date

Co-Borrower Date

Calyx Form - borcera.frm (10/2013)

Habitat for Humanity Sarasota, Inc.

Habitat for Humanity Sarasota, Inc.

Habitat for Humanity Sarasota, Inc.

Habitat for Humanity Sarasota, Inc.

Habitat for Humanity Sarasota, Inc.

Habitat for Humanity Sarasota, Inc.

Habitat for Humanity Sarasota, Inc.

Habitat for Humanity Sarasota, Inc.

(Print Name ____________________ )

Form

(March 2019) OMB No. 1545-1872

Signature

Title

Spouse's signature

(see instructions)

(if line 1a above is a corporation, partnership, estate, or trust)

Date

Date

Cat. No. 37667N Form (Rev. 3-2019)

Department of the TreasuryInternal Revenue Service

4506-T Request for Transcript of Tax ReturnDo not sign this form unless applicable lines have been completed.

Request may be rejected if the form is incomplete or illegible.For more information about Form 4506-T. visit www.irs.gov/form4506t.

1a 1b First social security number on tax return, individual taxpayer identificationnumber, or employer identification number (see instructions)

2a 2b Second social security number or individual taxpayeridentification number if joint tax return

3

4

5a

5b

Caution:

6 Transcript requested.

a Return Transcript,

b Account Transcript,

c Record of Account,

7 Verification of Nonfiling,

8 Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript.

Caution:

9 Year or period requested.

Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by usingour automated self-help service tools. Please visit us at IRS.gov and click on "Get a Tax Transcript . . ." under "Tools" or call 1-800-908-9946. If you need a copyof your return, use There is a fee to get a copy of your return.

Tip.

Form 4506, Request for Copy of Tax Return.Name shown on tax return. If a joint return, enter the name shown first.

If a joint return, enter spouse's name shown on tax return.

Current name, address (including apt., room, or suite no.), city, state, and ZIP code (See instructions)

Previous address shown on the last return filed if different from line 3 (See instructions)

If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party's name, address,and telephone number.

Customer file number (if applicable) (see instructions)

Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form number per request.

which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflectchanges made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series,Form 1065, Form 1120, Form 1120-A, Form 1120-H, Form 1120-L, and Form 1120S. Return transcripts are available for the current yearand returns processed during the prior 3 processing years. Most requests will be processed within 10 business days. . . . . . . .

which contains information on the financial status of the account, such as payments made on the account, penaltyassessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liabilityand estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 10 business days .

which provides the most detailed information as it is a combination of the Return Transcript and the Account Transcript. Available for current year and 3 prior tax years. Most requests will be processed within 10 business days . . . . . . . .

which is proof from the IRS that you file a return for the year. Current year requests are only availabledid notafter June 15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days . .

The IRS can provide a transcript that includes data fromthese information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide thistranscript information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. Forexample, W-2 information for 2011, filed in 2012, will likely not be available from the IRS until 2013. If you need W-2 information for retirementpurposes, you should contact the Social Security Administration at 1-800-772-1213. Most requests will be processed within 10 business days .

Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than fouryears or periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must entereach quarter or tax period separately.

Caution:

Do not sign this form unless all applicable lines have been completed.

I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax information requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or moreshareholder, partner, managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer. Icertify that I have the authority to execute Form 4506-T on behalf of the taxpayer.

Signatory attests that he/she has read the attestation clause and upon so reading declares that he/shehas the authority to sign the Form 4506-T. See instructions.

Phone number of taxpayer on line1a or 2a

Signature of taxpayer(s).

Note:

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

SignHere

4506-T

this form must be received by IRS within 120 days of the signature date.

If the tax transcript is being mailed to a third party, ensure that you have filled in lines 6 through 9 before signing. Sign and date the form onceyou have filled in these lines. Completing these steps helps to protect your privacy. Once the IRS discloses your tax transcript to the third party listedon line 5, the IRS has no control over what the third party does with the information. If you would like to limit the third party's authority to disclose your

transcript information, you can specify this limitation in your written agreement with the third party.

If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filedwith your return, you must use Form 4506 and request a copy of your return, which includes all attachments.

Calyx Form - Tax4506T1.frm (4/2019)

Mend

Mend

Habitat for Humanity Sarasota, Inc. 1757 North East Ave, Sarasota, FL 34234 941-365-0700

Form 1040

Habitat for Humanity Sarasota

Form 4506-T (Rev. 03-2019) Page 2

Section references are to the Internal RevenueCode unless otherwise noted.

Future DevelopmentsFor the latest information about Form 4506-T and itsinstructions, go to www.irs.gov/form4506t. Information about any recent developments affecting Form 4506-T (such aslegislation enacted after we released it) will be posted onthat page.What's New. The transcript Provided by the IRS have beenmodified to protect taxpayers' privacy. Transcripts only display partial personal information, such as the four digits of the taxpayer's social Security Number. Full financialand tax information, such as wages and taxable income, isshown on transcript.A new optional Customer File Number field is available to use when requesting a transcript. You have the option ofinputting a number, such as a loan number, in this field. You can input up to 10 numeric characters. The Customer filenumber should not contain an SSN. This number willprint onthe transcript. The customer file number is an optional field and not required.

General InstructionsCaution: Do not sign this form unless all applicable lineshave been completed.

Purpose of form. Use Form 4506-T to request tax returninformation. You can also designate (on line 5) a third party toreceive the information. Taxpayers using a tax year beginningin one calendar year and ending in the following year (fiscal

tax year) must file Form 4506-T to request a return transcript.

Note: If you are unsure of which type of transcript you need,request the Record of Account, as it provides the mostdetailed information.

Tip. Use Form 4506, Request for Copy ofTax Return, to request copies of tax returns.

Automated transcript request. You can quickly requesttranscripts by using our automated self-help service tools. Please visit us at IRS.gov and click on"Get a Tax Transcript ..." under "Tools" or call 1-800-908-9946.

Where to file. Mail or fax Form 4506-T to the address below for the state you lived in, or the state your business was in, when that return was filed.There are two address charts: one for individual transcripts(Form 1040 series and Form W-2) and one for all othertranscripts.

If you are requesting more than one transcript or other product and the chart below shows two different addresses,send your request to the address based on the address ofyour most recent return.

Chart for individual transcripts(Form 1040 series and Form W-2and Form 1099)If you filed an individual returnand lived in:

Mail or fax to:

Alabama, Kentucky, Louisiana, Mississippi, Tennessee,Texas, a foreign country,American Samoa, Puerto Rico,Guam, the Commonwealth ofthe Northern Mariana Islands,the U.S. Virgin Islands, or

A.P.O. or F.P.O. address

Internal Revenue ServiceRAIVS TeamStop 6716 AUSCAustin, TX 73301

855-587-9604

Alaska, Arizona, Arkansas,California, Colorado, Hawaii,Idaho, Illinois, Indiana, Iowa,Kansas, Michigan, Minnesota,Montana, Nebraska, Nevada,New Mexico, North Dakota,Oklahoma, Oregon, SouthDakota, Utah, Washington,

Wisconsin, Wyoming

Internal Revenue ServiceRAIVS TeamStop 37106Fresno, CA 93888

855-800-8105

Connecticut, Delaware, Districtof Columbia, Florida, Georgia,Maine, Maryland,Massachusetts, Missouri, NewHampshire, New Jersey, NewYork, North Carolina, Ohio,Pennsylvania, Rhode Island,South Carolina, Vermont,Virginia, West Virginia

Internal Revenue ServiceRAIVS TeamStop 6705 P-6Kansas City, MO 64999

855-821-0094

Chart for all other transcriptsIf you lived in or your business was in:

Mail or fax to:

Alabama, Alaska, Arizona,Arkansas, California,Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia,Hawaii, Idaho, IllinoisIndiana, Iowa, Kansas,Kentucky, LouisianaMaryland, Michigan,Minnesota, Mississippi,Missouri, Montana,Nebraska, Nevada, New Jersey, New Mexico, NorthCarolina, North Dakota, Ohio,Oklahoma, Oregon, RhodeIsland, South Carolina, SouthDakota, Tennessee, Texas,Utah, Virginia, Washington,

West Virginia, Wisconsin,Wyoming, a foreign country,American Samoa, PuertoRico, Guam, theCommonwealth of theNorthern Mariana Islands, the U.S. Virgin IslandsA.P.O. or F.P.O. address

Internal Revenue ServiceRAIVS TeamP.O. Box 9941Mail Stop 6734Ogden, UT 84409

855-298-1145

Maine, Massachusetts, NewHampshire, New York, Pennsylvania, Vermont

Internal Revenue ServiceRAIVS TeamStop 6705 S-2Kansas City, MO 64999

855-821-0094

Line 1b. Enter your employer identification number (EIN) ifyour request relates to a business return. Otherwise, enter thefirst social security number (SSN) or your individual taxpayeridentification number (ITIN) shown on the return. Forexample, if you are requesting Form 1040 that includes

Schedule C (Form 1040), enter your SSN.

Line 3. Enter your current address. If you use a P.O. box,include it on this line.

Line 4. Enter the address shown on the last return filed ifdifferent from the address entered on line 3.

Note: If the address on Lines 3 and 4 are different and youhave not changed your address with the IRS, file Form 8822,Change of Address. For a business address, file Form 8822-B, Change of Address or Responsible Party --- Business.

Line 5b.Enter up to 10 numeric characters to create a uniquecustomer file number that will appear on the transcript. The customer file number should not contain an SSN.Completion of this line is not required.

Note: If you use an SSN, name or combination of both, wewill not input the information and the customer file numberwill be blank on the transcript.

Line 6. Enter only one tax form number perrequest.Signature and date. Form 4506-T must be signed and dated by the taxpayer listed on line 1a or 2a. the IRS must receive Form 4506-T within 120 days of the date signed by the taxpayer or it will be rejected. Ensure that all applicable lines

are completed before signing.

You must check the box in the signature areato acknowledge you have the authority to signand request the information. The form will notbe processed and returned to you if the

box is unchecked.

Individuals. Transcripts of jointly filed tax returns may befurnished to either spouse. Only one signature is required. Sign Form 4506-T exactly as your name appeared on the original return. If you changed your name, also sign yourcurrent name.

Corporations. Generally, Form 4506-T can be signed by: (1) an officer having legal authority to bind the corporation, (2)any person designated by the board of directors or othergoverning body, or (3) any officer or employee on writtenrequest by any principal officer and attested to by thesecretary or other officer. A bona fide shareholder of recordowning 1 percent or more of the outstanding stock of thecorporation may submit a Form 4506-T but must providedocumentation to support the requester's right to receive theinformation.

Partnerships. Generally, Form 4506-T can be signed by any person who was a member of the partnership during anypart of the tax period requested on line 9.

All others. See section 6103(e) if the taxpayer has died, isinsolvent, is a dissolved corporation, or if a trustee, guardian,executor, receiver, or administrator is acting for the taxpayer.

Note: If you are Heir at law, Next of kin, or Beneficiary youmust be able to establish a material interest in the estate ortrust.

Documentation. For entities other than individuals, youmust attach the authorization document. For example, thiscould be the letter from the principal officer authorizing anemployee of the corporation or the letters testamentaryauthorizing an individual to act for an estate.

Signature by a representative. A representative can signForm 4506-T for a taxpayer only if the taxpayer hasspecifically delegated this authority to the representative onForm 2848, line 5. The representative must attach Form 2848showing the delegation to Form 4506-T.

Privacy Act and Paperwork Reduction Act Notice. We askfor the information on this form to establish your right to gainaccess to the requested tax information under the InternalRevenue Code. We need this information to properly identifythe tax information and respond to your request. You are notrequired to request any transcript; if you do request atranscript, sections 6103 and 6109 and their regulationsrequire you to provide this information, including your SSN orEIN. If you do not provide this information, we may not beable to process your request. Providing false or fraudulentinformation may subject you to penalties.

Routine uses of this information include giving it to theDepartment of Justice for civil and criminal litigation, andcities, states, the District of Columbia, and U.S.commonwealths and possessions for use in administeringtheir tax laws. We may also disclose this information to othercountries under a tax treaty, to federal and state agencies toenforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requestedon a form that is subject to the Paperwork Reduction Actunless the form displays a valid OMB control number. Booksor records relating to a form or its instructions must beretained as long as their contents may become material in theadministration of any Internal Revenue law. Generally, taxreturns and return information are confidential, as required bysection 6103.

The time needed to complete and file Form 4506-T willvary depending on individual circumstances. The estimatedaverage time is:Learning about the law or the form, 10min.; Preparing the form,12 min.; and Copying,assembling, and sending the form to the IRS, 20 min.

If you have comments concerning the accuracy of thesetime estimates or suggestions for making Form 4506-Tsimpler, we would be happy to hear from you. You can write to:

Internal Revenue Service Tax Formsand Publications Division 1111Constitution Ave. NW, IR-6526 Washington, DC 20224

Do not send the form to this address Instead, see Whereto file on this page.

Calyx form - Tax4506T2.frm (3/2019)

Habitat for Humanity Sarasota

Social Security AdministrationPage 1 of 2

OMB No.0960-0760

Authorization for the Social Security Administration (SSA) To Release Social Security Number (SSN) Verification

Printed Name: Date of Birth: Social Security Number:

I want this information released because I am conducting the following business transaction:

Reason(s) for using CBSV: (Please select all that apply)Mortgage ServiceBackground CheckCredit Check

Banking ServiceLicense RequirementOther

with the following company ("the Company"):

Company Name:

Company Address:

I authorize the Social Security Administration to verify my name and SSN to the Company and/or theCompany's Agent, if applicable, for the purpose I identified.

The name and address of the Company's Agent is:

I am the individual to whom the Social Security number was issued or the parent or legal guardian of aminor, or the legal guardian of a legally incompetent adult. I declare and affirm under the penalty ofperjury that the information contained herein is true and correct. I acknowledge that if I make anyrepresentation that I know is false to obtain information from Social Security records, I could be foundguilty of a misdemeanor and fined up to $5,000.

This consent is valid only for 90 days from the date signed, unless indicated otherwise by theindividual named above. If you wish to change this timeframe, fill in the following:

This consent is valid for days from the date signed. (Please initial.)

Signature: Date Signed:

Relationship (if not the individual to whom the SSN was issued):

Contact information of individual signing authorization:

Address:

City/State/Zip:

Phone Number:

Form (02-2018)Discontinue Previous Editions

SSA-89

Mend

Mortgage

Habitat for Humanity Sarasota

1757 North East Ave, Sarasota, FL 34234

Automation Research, Inc. (d/b/a DataVerify)

875 Greentree Road 8 Parkway Center

Pittsburgh, PA 15220

Privacy Act StatementCollection and Use of Personal Information

Sections 205(a) and 1106 of the Social Security Act, as amended, allow us to collect this information.Furnishing us this information is voluntary. However, failing to provide all or part of the information mayprevent us from releasing information to a designated company or company’s agent.

We will use the information to verify your name and Social Security number (SSN). In addition, we mayshare this information in accordance with the Privacy Act and other Federal laws. For example, whereauthorized, we may use and disclose this information in computer matching programs, in which ourrecords are compared with other records to establish or verify a person’s eligibility for Federal benefitprograms and for repayment of incorrect or delinquent debts under these programs.

A list of routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0058, entitledMaster Files of SSN Holders and SSN Applications. Additional information and a full listing of all ourSORNs are available on our website at www.socialsecurity.gov/foia/bluebook.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need toanswer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 3 minutes to complete the form. You may send comments on our time time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send to this addressonly comments relating to our time estimate, not the completed form.

NOTICE TO NUMBER HOLDERThe Company and/or its Agent have entered into an agreement with SSA that, among other things,includes restrictions on the further use and disclosure of SSA's verification of your SSN. To view a copy ofthe entire model agreement, visit http://www.ssa.gov/cbsv/docs/SampleUserAgreement.pdf.

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Form (02-2018) Page 2 of 2SSA-89